Ethical Leadership in Healthcare: One Key Element

“Functioning as our better selves leads to better outcomes for patients and everyone.”

Tarris (Terry) Rosell, PhD, DMin, HEC-C

Published March 2026

Leadership is having a moment.

Across sectors and across nations, we are watching leaders choose between intimidation and integrity, dominance and dignity. In times of geopolitical tension and uncertainty, fear spreads quickly. Headlines move faster than reflection, outpacing even the fear they inspire. Decisions feel outsized, consequential and destabilizing. In these moments, leadership matters profoundly.

When anxiety rises, there is often pressure toward forceful, unilateral action – toward displays of strength that prioritize control over deliberation. But strength and ethical leadership are not opposites. True strength is disciplined. It is measured. It is anchored in justice. I believe this is particularly true in healthcare. The stakes are not merely financial or reputational – they are human. The decisions leaders make shape policies, culture, clinician well-being, and ultimately patient care.

Ethical Leadership Improves Performance

What, then, actually defines leadership? Is it power exercised through fear? Or influence exercised through ethical example? A recent study published in Nature, “Ethical Leadership and Organizational Excellence: The Mediating Role of Citizenship Behavior in Healthcare” (Almanbahi et al., 2025), suggests that the answer is neither abstract nor sentimental. Ethical leadership –- grounded in fairness, integrity, and transparency – is statistically associated with measurable organizational excellence. Employees who perceive their leaders as ethical report stronger organizational citizenship behaviors and higher levels of institutional performance. As the authors note, “the five factors traditionally used in defining organizational citizenship behavior are altruism, courtesy, sportsmanship, conscientiousness, and civic virtue.”

The empirical findings are notable. But what is perhaps most compelling is not simply that ethical leadership “improves performance,” but why.

At the center of ethical leadership lies the principle of justice. Justice in leadership is not rhetorical commitment to fairness; it is lived fairness. It is the transparent allocation of resources. It is consistent decision-making. It is ensuring that policies apply equally, that expectations are clear, and that individuals are treated with respect rather than favoritism or fear. Justice is not softness – it is structural and cultural integrity.

Justice Strengthens Leadership

In healthcare systems and beyond, I believe that justice is integral to a functioning framework. When clinicians believe decisions are made transparently and equitably, trust increases. When trust increases, cooperation increases. When cooperation increases, quality improves. Conversely, when leadership lacks justice – when decisions appear arbitrary or self-protective or bullying – moral distress proliferates.

Moral distress frequently occurs when professionals recognize the ethically appropriate course of action but feel constrained from acting due to institutional or hierarchical barriers. Originally described in nursing, it is now understood to affect physicians, administrators, social workers, and interdisciplinary teams alike. Almost certainly every person reading this has experienced some level of moral distress in their professional lives. It erodes morale, contributes to burnout, and ultimately threatens patient safety. Addressing moral distress is not optional – it is central to ethical healthcare operations and something we care deeply about at the Center.

The Cost of Moral Distress

The connection between ethical leadership and moral distress is not incidental. Leaders who prioritize justice reduce the frequency and intensity of situations in which clinicians feel ethically compromised. Fair workload distribution, transparent triage processes, equitable access to resources, and consistent communication all mitigate the internal conflict that characterizes moral distress. In addition, when leaders embody justice, they create psychological safety. Teams feel secure enough to raise concerns, question decisions, and advocate for patients without fear of retaliation. This environment reduces suppressed ethical tension and prevents the chronic accumulation of moral distress. Excellence emerges from structural fairness.

Healthcare reform efforts across the globe emphasize innovation, efficiency, and performance metrics. Yet performance detached from justice is fragile and scary. Organizations may temporarily achieve data targets – but at the cost of clinician well-being. Burned-out clinicians cannot sustain excellence, thus making any reform effort excluding the principle of justice short-sighted and ultimately ineffective.

Ethics Integral to Operations

Importantly, ethical leadership does not mean universal agreement or the absence of difficult decisions. Healthcare resources are finite. Trade-offs are inevitable. Justice in leadership means those decisions are made transparently, consistently, and with acknowledgment of their ethical dimensions.

Leaders who model fairness signal that ethical concerns are legitimate operational considerations – not distractions from efficiency. This reduces the destructive sense that clinicians must choose between professional integrity and institutional loyalty.

In uncertain and frightening times, modeling ethical leadership is not abstract philosophy. It is practical necessity. It reminds us that authority can coexist with humility, that decisiveness can coexist with deliberation, and that strength can coexist with restraint.

If healthcare organizations seek durable excellence – excellence that survives leadership transitions, financial strain, and reform cycles – the cultivation of ethical leadership is not aspirational. It is necessary. Because when justice is present, moral distress diminishes. And when moral distress diminishes, clinicians can focus on what they are trained to do: care.

Source

Ethical leadership and organizational excellence: the mediating role of citizenship behavior in healthcare | Humanities and Social Sciences Communications

Mr. Blake is a 61-year-old gentleman suffering from respiratory distress after being found down and unresponsive outside. He has a history of mental health disorders, with which he has been inconsistent in treatment, and homelessness. Upon admission eight days ago, he was intubated but has not been able to regain consciousness and therefore cannot participate in medical decisions.

Mr. Blake does not have an advance directive or any known friends and/or family who can speak on his behalf. While his condition has not improved during hospitalization, it has also not declined. Several members of the medical team are questioning whether it is better to continue or withdraw aggressive measures.

Dr. Intera has been the primary attending throughout Mr. Blake’s hospitalization and has been advocating for continuing all current interventions. Dr. Intera believes that Mr. Blake simply needs more time and will likely improve in the coming days, despite the opinions of several other members of the care team. Other team members believe that Dr. Intera may be prolonging Mr. Blake’s death rather than saving his life and allowing his suffering to continue.

An ethics consult is requested.

A logical fallacy is invalid or flawed reasoning when making an argument. If someone is making an argument, or in other words presenting a rational point that follows a line of reasoning, a fallacy will weaken or discredit that argument.

There are many different types of fallacies, and philosophers are always mindful to avoid them. A common fallacy is an ad hominem fallacy, or an ad hominem attack, which is “where individuals attack their opponents’ character instead of addressing the arguments presented. The term, derived from the Latin phrase meaning ‘to the man,’ highlights the flawed reasoning behind such attacks, which aim to discredit a viewpoint based on the perceived flaws or affiliations of the person asserting it” (https://www.ebsco.com/research-starters/religion-and-philosophy/ad-hominem).

The Individual or The Argument

It is important to keep the focus on the individual arguments rather than attacking the person making the argument. If someone were to say, “I think it is best when people donate to charity,” and someone countered by saying, “But you never donate to charity yourself,” that would be ad hominem because it does not address the argument of whether it is right or wrong to donate to charity, but instead attacks the individual making the argument. It is generally viewed as a flawed argument and should be avoided.

But that is not to argue that the individual person should not be considered at all. From the perspective of virtue ethics, it is extremely important. As the name implies, virtue ethics “emphasizes the virtues, or moral character, in contrast to approaches that emphasize duties or rules (deontology) or that emphasize the consequences of actions (consequentialism)” (https://plato.stanford.edu/entries/ethics-virtue/).

Other ethical systems, such as deontology and consequentialism, are more focused on arguments and the events that occur outside of the person, rather than on the individual person themselves. These are contexts where the ad hominem fallacy is more applicable, as the moral character of a person does not matter if that person followed his or her duty or produced a desirable outcome.

The Human Factor

There is something deeply human in the approach of virtue ethics, and thus something valuable. In his paper, “The Schizophrenia of Modern Ethical Theories,” Michael Stocker (https://www.jstor.org/stable/2025782) argues that the intention and moral character of a person matter, not just the action, using the following example. Say you are in the hospital, and a friend comes to visit. You enjoy your time together, but at the end your friend says that the only reason he or she came was because he or she felt obligated to do so. How would you feel? Something would be missing. The intention matters. The moral character matters.

Virtues and moral character are very difficult to determine and define. A non-virtuous person may still make good decisions, follow duties, and produce good results. Ethical leadership goes beyond simply producing results. People want to know that deeper things are being considered. A leader who demonstrates the virtues of honesty, integrity, and compassion is probably more likely to make decisions that others feel are ethically sound. Of course, a leader who does not demonstrate these virtues may still be effective, but as Stocker argues, something would be missing.

 Sources

Ad hominem | Religion and Philosophy | Research Starters | EBSCO Research

The Schizophrenia of Modern Ethical Theories on JSTOR

Virtue Ethics (Stanford Encyclopedia of Philosophy)

Written By Ryan Pferdehirt, D.Bioethics, HEC-C, Vice President of Ethics Services, Rosemary Flanigan Chair & Cassie Shaffer Johnson, MA, Program Director of Ethics Services